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Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS.

Authors
  • Luyt, Charles-Edouard1
  • Combes, Alain2
  • Becquemin, Marie-Hélène3
  • Beigelman-Aubry, Catherine4
  • Hatem, Stéphane5
  • Brun, Anne-Laure4
  • Zraik, Nizar3
  • Carrat, Fabrice6
  • Grenier, Philippe A4
  • Richard, Jean-Christophe M7
  • Mercat, Alain8
  • Brochard, Laurent9
  • Brun-Buisson, Christian10
  • Chastre, Jean2
  • 1 Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France. Electronic address: [email protected] , (France)
  • 2 Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France. , (France)
  • 3 Service d'Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France. , (France)
  • 4 Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France. , (France)
  • 5 Service d'explorations fonctionnelles cardio-vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France. , (France)
  • 6 Service de Santé Publique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Unité Mixte de Recherche-S 707, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 6-Pierre-et-Marie-Curie, Paris, France. , (France)
  • 7 Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, Rouen.
  • 8 Service de Réanimation Médicale, Centre Hospitalier Universitaire d'Angers, Angers, France. , (France)
  • 9 Intensive Care Unit, Hôpitaux Universitaires de Genève, Genève, Switzerland. , (Switzerland)
  • 10 Service de Réanimation Médicale, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France. , (France)
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
Sep 01, 2012
Volume
142
Issue
3
Pages
583–592
Identifiers
DOI: 10.1378/chest.11-2196
PMID: 22948576
Source
Medline
Language
English
License
Unknown

Abstract

No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate. Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m²) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated. At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%). One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes. ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov

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